Safinamide is a monoamine oxidase B (MAO-B) inhibitor marketed in several countries under the brand name Xadago by Newron Pharmaceuticals for the treatment of levodopa wear-off in Parkinson’s disease (PD). At the 10th Congress of the European Academy of Neurology (EAN) 2024, Dr. Ester Morales García presented a pharmacoeconomic report comparing safinamide to its competitor rasagiline (Teva’s Azilect). Safinamide performed better than rasagiline in terms of efficacy, safety, and in a cost-efficacy assessment. These results corroborate forecasts that predict the growth of Xadago in the seven major markets (7MM*) at a compound annual growth rate (CAGR) of 5.1%, and a decline for Azilect at a negative CAGR of 0.8% between 2019 and 2029, according to GlobalData, a leading data and analytics company.
Lorraine Palmer, Pharma Analyst at GlobalData, comments: “The pharmacoeconomic analysis evaluated 49 results across meta-analysis and systematic reviews evaluating placebo-controlled trials with data released before September 2023. Safinamide performed better than rasagiline in Unified Parkinson’s Disease Rating Scale [UPDRS] scores, the risk ratio for serious adverse events, and withdrawals due to adverse events.”
Although rasagiline is less expensive than safinamide, due to safinamide being more efficient with better ‘number needed to treat’ (NNT) values for ON-time and OFF-time, the incremental cost-effectiveness ratio (ICER) of using safinamide over rasagiline ranged between €1700 and €10,000. Since the researchers had established a threshold value (i.e., a willingness-to-pay value, anything above this would be deemed too expensive and not cost-effective) of €22,000, and safinamide’s ICER was below this, it was deemed to be cost-effective.
Palmer continues: “Despite determining that the use of safinamide is more cost-effective than rasagiline, the pharmaeconomic analysis also recognizes that there are circumstances that make the lower cost of rasagiline potentially more competitive. The pharmaeconomic report notes that, if working with a fixed budget, treating with rasagiline over safinamide would allow more patients access to treatment. Key opinion leaders [KOLs] based in the US and interviewed by GlobalData noted that it was difficult to obtain insurance coverage with safinamide as there are cheaper generic MAO-B inhibitors available, such as rasagaline.”
According to GlobalData’s Parkinson’s disease market forecast and analysis to 2029, Xadago [branded safinamide] is set to experience growth in 7MM, with anticipated sales increasing from $1.5 million in 2024 to $4.7 million in 2029. This growth will be driven by sales in France, Germany, Spain, and the UK.
On the other hand, Azilect has higher sales due to its presence in the market for approximately 10-years longer than Xadago. However, it is expected to experience a decline, with estimated sales decreasing from $95.8 million in 2024 to $75.8 million in 2029 due to generic availability and competition with Xadago.
Palmer concludes: “The dynamics of the PD market are continually shifting. MAO-B inhibitors such as Xadago and Azilect also face competition from other drug classes such as catechol-O-methyltransferase (COMT) inhibitors like Amneal/Bial’s Ongentys (opicapone), which was heavily featured in EAN presentations this year focusing on its positive outcomes in a real-world setting. GlobalData will re-examine these shifting dynamics and expects to publish a report forecasting the market to 2033.”
*7MM- the US, the UK, Germany, Spain, Italy, France, and Japan
